Provider Demographics
NPI:1114151974
Name:HEATHER L BOWLES
Entity Type:Organization
Organization Name:HEATHER L BOWLES
Other - Org Name:PHYSICIANS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-478-7902
Mailing Address - Street 1:4390 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:LARUE
Mailing Address - State:TX
Mailing Address - Zip Code:75770-4758
Mailing Address - Country:US
Mailing Address - Phone:800-478-7902
Mailing Address - Fax:800-517-3583
Practice Address - Street 1:4390 PINE CREST DR
Practice Address - Street 2:
Practice Address - City:LARUE
Practice Address - State:TX
Practice Address - Zip Code:75770-4758
Practice Address - Country:US
Practice Address - Phone:800-478-7902
Practice Address - Fax:800-517-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204751601Medicaid
TX204751601Medicaid